中药干预对22例2型糖尿病颈动脉内中膜厚度动态变化的影响

发布时间：2018-05-27 02:01

本文选题：颈动脉内中膜厚度 + 2型糖尿病　；参考：《北京中医药大学》2016年硕士论文

【摘要】：本研究论文主要分为两部分：综述和临床研究。综述又分为现代医学综述和中医学综述。现代医学综述部分主要介绍了糖尿病大血管病变流行病学情况、发病的主要机制、诊断方法、相关的实验室指标、目前治疗研究的进展及可能的不良反应作用做了相关整理。提示糖尿病大血管病变发病机制复杂,相关研究主要从多元醇通路、晚期糖化终产物、胰岛素抵抗、血脂异常、炎症等多方面阐释,其治疗主要以降糖、控压、调脂等对因处理,其疗效评价有待进一步完善和综合考量。中医学综述部分,笔者检索了近15年来关于糖尿病大血管病变的中医诊治的部分相关研究,简要概述了中医对糖尿病大血管病变病因病机、临床分型、辨证论治的研究进展,并对不同类型的大血管病变分别进行了梳理,同时对相关中药的最新研究也进行了学习,初步认为中医和中西医结合对糖尿病大血管并发症的治疗有一定的特色和优势。临床研究目的探讨中药干预对2型糖尿病颈动脉内中膜厚度动态变化的影响。方法采用回顾性研究,以2010年1月至2015年12月在北京医院内分泌科及中医科住院病人为研究对象,根据纳入、排除标准,筛选出以西医规范的降糖、降压、调脂治疗为基础且数据资料完整的42份病历,分为两组：中药干预组22例,暴露于中药干预,于住院及门诊口服中药,中药剂量及种类由接诊医生通过中医辨证开具；对照组20例,未暴露于中药干预,即单纯西医常规治疗。42份病历于2010年1月至2015年12月住院3次,2次住院间隔时间1-1.5年。观察主要指标：3次住院期间颈动脉内中膜厚度,比较两组之间动态变化情况的差异；次要指标：空腹静脉血糖,血清总胆固醇、甘油三酯、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、糖化血红蛋白、血清尿酸、血清尿素氮,血清肌酐等。结果两组颈动脉内中膜厚度整体较前变薄,中药干预组内中膜厚度变薄幅度较西医常规治疗组的大,但无统计学差异(P=0.083)；合并心脑血管病变患者内中膜厚度(1.7±0.6(mm))和不合并心脑管病变患者内中膜厚度(1.4±0.2(m))有明显统计学差异(P0.05)；两组患者在第2次住院时,次要观察指标肌酐(SCr)中药干预组64±16(mmol/L)低于西医常规治疗组75±15(mmol/L),且结果有统计学差异(P0.05)。患者第三次住院时中药干预组糖化血红蛋白(7.7±1.03(%))较对照组(8.54±1.53(%))低,但结果无统计学意义(P=0.058)；患者第二次入院时对照组FIB-C(2.85±0.50g/L)比中药干预组(3.47±0.83g/L)低,有显著统计学差异(P=0.006)。结论中药干预联合西药常规治疗对2型糖尿病颈动脉内中膜厚度的改善程度可能优于单纯西药常规治疗；颈动脉内中膜厚度和心脑血管并发症相关；中药干预可能对该组病患的肾功能有保护作用；中药干预联合西药常规治疗可能能够更有效的降低患者HbA1c水平。
[Abstract]:This research paper is divided into two parts: summary and clinical research. The review is divided into modern medicine review and traditional Chinese medicine review. The part of modern medicine review mainly introduces the epidemiology of diabetic macroangiopathy, the main pathogenesis, diagnostic methods, related laboratory indexes, the progress of current treatment research and possible adverse reactions. It is suggested that the pathogenesis of diabetic macroangiopathy is complicated, and the related studies mainly include polyol pathway, advanced glycosylation end products, insulin resistance, dyslipidemia, inflammation and so on. The evaluation of the therapeutic effect of lipid adjustment and other factors needs further improvement and comprehensive consideration. In the part of summary of traditional Chinese medicine, the author searched some related studies on the diagnosis and treatment of diabetic macrovascular disease in the past 15 years, and briefly summarized the research progress of TCM in the etiology, pathogenesis, clinical classification, syndrome differentiation and treatment of diabetic macrovascular disease. Different types of macrovascular diseases were combed, and the latest research on traditional Chinese medicine was also studied. It was preliminarily concluded that the treatment of diabetic macrovascular complications by TCM and Western medicine has certain characteristics and advantages. Objective to investigate the effect of traditional Chinese medicine (TCM) intervention on the dynamic changes of carotid artery thickness in type 2 diabetes mellitus. Methods from January 2010 to December 2015, the inpatients in the Department of Endocrinology and the Department of traditional Chinese Medicine of Beijing Hospital were studied by retrospective study. According to the inclusion and exclusion criteria, the standard of lowering blood sugar and blood pressure in western medicine was selected. 42 cases with complete data were divided into two groups: Chinese medicine intervention group (22 cases) exposed to Chinese medicine intervention, oral Chinese medicine in inpatient and outpatient department, and the dosage and type of traditional Chinese medicine were prescribed by TCM syndrome differentiation. In the control group, 20 cases were not exposed to the intervention of traditional Chinese medicine, that is, 42 cases of routine western medicine were hospitalized 3 times from January 2010 to December 2015. The interval between hospitalization and hospitalization was 1-1.5 years. Main outcome measures: carotid intima-media thickness was observed during three hospitalizations, and the difference of dynamic changes between the two groups was compared. Secondary measures: fasting venous blood glucose, serum total cholesterol, triglyceride, low density lipoprotein cholesterol, High density lipoprotein cholesterol, glycosylated hemoglobin, serum uric acid, serum urea nitrogen, serum creatinine, etc. Results the intima media thickness of carotid artery in both groups was thinner than that in the former group, and the thickness of internal media in the Chinese medicine intervention group was larger than that in the routine western medicine treatment group. However, there was no statistical difference between the two groups (P < 0.083; medial thickness was 1.7 卤0.6mm in patients with cardiovascular and cerebrovascular diseases) and that in patients without cardio-cerebral canal disease was 1.4 卤0.2mm); there was a significant difference between the two groups in the second hospitalization, and there was no significant difference between the two groups (P < 0.05). The index of creatinine in the intervention group (64 卤16 mmol/ L) was lower than that in the conventional western medicine group (75 卤15 mmol / L), and the difference was statistically significant (P 0.05). The glycosylated hemoglobin in the intervention group (7.7 卤1.03g / L) was lower than that in the control group (8.54 卤1.53g / L), but the results were not statistically significant, and the FIB-C(2.85 卤0.50g / L in the control group on the second admission was lower than that in the Chinese medicine intervention group (3.47 卤0.83g / L), there was significant difference between the two groups (P 0.006). Conclusion the degree of improvement of carotid intima-media thickness in type 2 diabetes mellitus may be better than that of traditional Chinese medicine intervention combined with routine treatment of western medicine, which is related to cardiovascular and cerebrovascular complications. The intervention of traditional Chinese medicine may protect the renal function of the patients, and the intervention of traditional Chinese medicine combined with routine therapy of western medicine may reduce the level of HbA1c more effectively.
【学位授予单位】：北京中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R259

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